성장 인자(growth factor), 활성화 된 기질(activated stroma), DNA-손상 유발 물질 및 다른 많은 요인들이 관련되어 있음이 알려져 있다15. 또한 최근 연구들에서 급성 및 만성 염증이 종양 괴사 인자-알파(tumor necrosis factor-α), 인터루킨-1(interleukin-1)과 같은 여러 종류의 사이토카인과 함께 세포 DNA의 손상 및 변형을 일으켜 종양을 유발 시킬 뿐만 아니라, 염증 환경이 지속되는 동안, 핵인자-kB(nuclear factor-kB), nuclear factor of activated T cell(NFAT), signal transducer and activator of transcription 3(STAT3), 일산화 질소(NO), 사이클로옥시지나제-2(cyclooxygenase-2), 표피 성장 인자(epidermal growth factor), 금속 단백 분해 효소(Matrix metalloproteinases), 케모카인(Chemokines)과 같은 여러 인자들과 저 산소 환경 등이 관련 되어 종양의 성장, 주위 조직으로의 침윤 및 전이가 일어나는 것으로 보고 되었다28. 현재까지 염증과 말기 암의
예후에 관한 정확한 기전이 밝혀진 것은 없으나, 그 동안의 많은
직전의 NLR이 수술 이후의 생존기간 예측을 위한 유용한 예후 인자가
이를 보정하지 못한 점과 입원 중에 시행된 치료의 종류가 동일 하지 못한 점 등의 한계가 있었다.
V. 결 론
이번 연구 결과에서 말기 암환자의 생존기간의 중앙값은 14일 이었으며, 생존기간의 독립적인 예후 인자는 NLR과 ECOG 점수로 나타났다.
NLR은 저렴하며 임상에서 빠르게 확인 할 수 있고 실제 말기 암 환자들 대부분에서 시행하고 있는 기본 혈액 검사를 통해 확인 할 수 있는 염증지표이다. 본 연구에서 NLR이 가장 높은 군 (≥12.5)에서 환자의 생존기간이 통계적으로 유의하게 짧았다. 또한 NLR의 평균값은 사망이 임박한 시점에서 유의한 증가를 보였다.
결론적으로 말기 암환자에서 정기적으로 NLR을 확인 하는 것이 생존기간을 예측 함에 있어서 효율적이며 유용한 방법이 될 수 있다.
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영문 요약
Neutrophil-Lymphocyte Ratio as a prognostic factor in terminally ill cancer patients
Cho, Wan Je Department of Medicine
The Graduate School, Yonsei University (Directed by Professor Sim, Jae Yong)
Background: It is important to estimate the survival time of a terminally ill cancer patient as accurate as possible in order to establish efficient palliative treatment plans. Proper estimation of life expectancy aids in improving the quality of life of the patient; it also promotes productive communication between the medical staff and the patient. The aim of this study is to determine the efficacy of neutrophil-lymphocyte ratio (NLR) as a predictor of survival time in terminally ill cancer patients.
Methods: Between January 2004 and June 2007, sixty-seven terminally ill cancer patients who were admitted or transferred
for palliative care, were included. Patients were categorized into three groups by NLR. Demographic characteristics, clinical characteristics, blood samples and Chest PA were analyzed.
Results: In univariate analysis, survival time of the highest NLR group(≥12.5) was significantly shorter than that of the others(HR: 3.444, P<0.001). After adjustment for low performance status(ECOG score 4), high NLR(≥12.5) was significantly and independently associated with short survival time(HR=2.821, P=0.007). Neutrophil-Lymphocyte Ratio was also significantly increased before death(P=0.001).
Conclusion: Neutrophil-Lymphocyte Ratio can be useful in predicting life expectancy in terminally ill cancer patients.